Endemic Typhus in Alabama

History, Rats, Fleas, and Opossums: The Ascendency of Flea-Borne Typhus in the United States, 1910–1944

“…Maxcy reported that African Americans rarely contracted the infection; for example, in Savannah, GA in 1920, only 2.2% of the cases of FBT were observed in African-Americans, even though they comprised 47% of the population [96]. A similar racial disparity was also noted in series from AL in 1935 and 1943 [31,98]. However, it was not known if this was due to true decreased biological susceptibility of African-Americans, lesser access to medical care, underreporting of disease in this group overall, or misdiagnosis due to difficulty in detecting the rash on darker skin [14,31,99].…”

“…The most highly endemic areas of the country for FBT in the 1920s and 1930s were southern GA, southeastern AL, and southeastern TX [128]. In AL, the incidence of disease increased from about 80 cases/year in 1931 to 237 in 1932 and 823 in 1933 [98]. In the period 1922-1939, GA reported 6225 cases of FBT; AL, 3751 cases; and TX, 3277 cases, with 84%, 85%, and 62% of the counties in these states, respectively, reporting cases.…”

“…In TX, one million rats were killed in 1933 [13] (Figure 4). Four million rats were eradicated by the CWA in 21 of Alabama's 67 counties (Figure 4) and typhus cases in 1934 decreased by 79% compared to 1933 [98]. However, these rat control programs were discontinued in 1934.…”

“…Two other high incidence cities were Atlanta, GA and Charleston, SC, with 354 and 309 cases, respectively, during the same period [128]. In the pre-antibiotic era, in two hospital-based series (Grady Hospital in Atlanta, GA and Charity Hospital in New Orleans, LA), the mortality rate of FBT was less than 1% [137,138]; however, mortality rates ranged from 3.6% to 7.6% in published series from 1922-1944 [5,16,98], and were significantly higher (30%) for those older than 65 years [100]. The Baltimore City Health Department reported a 22% mortality rate in 59 patients from 1927 to 1947 [139].…”

“…It was no coincidence that the states with the largest peanut crop (AL, GA, and TX) [194] also had the most cases of FBT [128]. In GA and AL, FBT cases were clustered in the regions of greatest peanut production, the southwestern and southeastern corners of the states, respectively [77,98,100]. For example, in 1943, the incidence of FBT in Coffee County in southeastern AL was 500 cases/100,000 [31] (by comparison, the incidence rate of Lyme disease in CT, the state with the highest incidence, was 98/100,000 in 1999) [196].…”